As a medical resident, I saw a 4-year-old girl with a large tear in her vagina that required surgery to put it back together. I couldn’t image what had happened. The family said she fell on the top of a plunger. The examination (and common sense) said otherwise. The mother’s boyfriend was eventually prosecuted for sexual abuse.

I’ve seen many more cases during my time as a pediatrician. I’ve collected evidence from young victims’ bodies, scraping their mouths and privates with cotton swabs, pulling hair from their heads and pubic areas, and taking pictures of marks and bruises. I’ve tested children for gonorrhea, chlamydia, syphilis and HIV. I’ve testified in court and worried if what I said would do more harm than good.

Sex abuse is an incredibly harsh reality in our society. According to the Nation Crime Victims Survey, one in every five girls and one in every 10 boys will be sexually abused in their lifetime. It’s likely you know a child who has been or will be abused.

Just as startling is that most perpetrators start at a young age — more than one-third of all sexual crimes against children are committed by juveniles. Adult offenders report their first criminal act occurred at the average age of 14.

What’s even scarier is this epidemic goes largely undetected. Only 5 to 15 percent of children ever tell anyone the abuse is happening. Most perpetrators will never be caught because no one will ever expose them. It’s even difficult to tell from a medical perspective as a very small percentage of child sex abuse victims have any abnormalities during physical exams.

This is why parents and caregivers must know the warnings signs. Sex abuse often happens because most adults don’t know what to look for and don’t want to believe it.

The perpetrators aren’t stupid. They target specific children, families, job opportunities and communities where they have access to a large number of children. They gain trust of the family so if a child ever tells on them it will be incredibly hard for someone to believe the child. They begin slowly exposing children to physical touching such as “wrestling, hugging, tickling, massages and backrubs” then begin sexualized talk, exposure to nudity and eventually physical sexual encounters.

Child sexual abuse is usually not just a single event but occurs over time. Perpetrators look to fill voids a child or family has, such as single parents, uninvolved parents or children with lack of boundaries. They may shower a child with attention, affection, special privileges or gifts.

Children may drop hints of sex abuse. For example, a child may say “Joey (her older brother) is bothering me at night.” If a parent asks more questions, she may then say “He’s coming into my room at night and touching me.”

Parents must be open, caring and nonjudgmental. Always believe the child and get help — the instances of children making up sex abuse stories is extremely small.

Tips on how to prevent sex abuse:

1.Use appropriate language when you talk about your children’s genitalia, such as vagina, breasts and penis instead of private areas.
2.Talk about how it’s not OK for someone to ask to see, touch or take pictures of your child’s genitals.
3.If you find your children looking at each other’s genitals or they have searched pictures on the internet, stay calm. Ask open-ended questions and have a discussion about it.
4.Set age-appropriate limits for TV, radio, music, games and internet access.
5.Monitor your child’s social media and internet use. Consider not allowing your child to have internet access alone in their bedroom.
6.Be aware of any adult who seems more interested in your child than you.
7.Check the sex offender registry.

Signs of sex abuse in a child:

1.Increased sexualized behaviors, such as acting seductively or sexually through dolls or toys
2.More sexual knowledge beyond normal level of development
3.Sleep problems and eating disorders, such as bulimia, anorexia or overeating
4.Bowel problems, such as soiling oneself or genital/rectal pain or bleeding
5.Sudden or unexplained personality changes, including aggression, fear and depression
6.Thoughts or talking about suicide
7.Drop in school performance
8.Drug use
9.Running away from home
10.Resistance to spending time with a certain adult or asking to spend more time with them due to gifts and attention

All Kentuckians are required to report suspected child abuse. Call (877) KY-SAFE1. For more information, visit stopitnow.org or call (800) CHILDREN.

– Erin Frazier, M.D.
Pediatrician, Norton Children’s Hospital Medical Associates
Medical Director, Children’s Hospital Foundation Office of Child Advocacy of Norton Children’s Hospital

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Child abuse is everyone’s concern — and it’s 100 percent preventable. Click on the slideshow below for tips on how you can help stop abuse and save a child’s life.

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An abused child comes to Norton Children’s Hospital almost every day. I was first introduced to the horrors of child abuse when I was a resident. A 3-month-old was brought into the emergency room for “not acting right.” When I entered the patient’s room, it was obvious the baby was having a seizure. We quickly moved the baby to a trauma room, where a scan showed severe brain swelling. Shortly after, she died.

Fast-forward a few years to when I treated a toddler who was beaten by her mother’s boyfriend. The forensic team was gathering evidence and noticed bruising on her scalp. They shaved her blonde curls to reveal an impression of a steel boot — the boyfriend literally had stomped on the girl’s head. She did not survive.

There are others. I’ve seen belt marks on a child’s back. One who was slapped in our waiting room, leaving a handprint on her face. A 5-year-old boy beaten by his father for hoarding food in his bedroom.

These haunting images drive me to continue fighting to prevent child abuse. And it’s a tough fight. Last year in Kentucky and Indiana, more than 40,000 cases of abuse and neglect were reported, leaving hundreds of innocent kids with permanent physical and emotional damage. Dozens of them didn’t even survive.

Child abuse is everyone’s concern — not just professionals who deal with children. Fortunately, each and every one of us can help stop abuse:

•If you’re a parent and you feel yourself about to lose control, it’s OK to step away. Listen to your favorite song, take a few deep breaths or call a friend.
•Keep a list of friends’ and family members’ phone numbers to call for support.
•Learn the TEN-4 bruising rule: Children under age 4 should not have bruising on the torso, ears or neck. Infants that are not mobile should never have any bruises. If you see these bruises, there is a good chance the child is being abused and you can do something before it’s too late.
•If you know a parent who may need a break, offer to babysit so he or she can have a break for an hour or two.
•Offer to run an errand for a neighbor with small children who has difficulty getting out of the house. A small gesture like that can greatly reduce stress for the parent.
•If you see someone about to raise a hand to a child, ask them if they need assistance. Sometimes the situation just needs an interruption.

Together, we can save the lives of countless innocent children in our community. Find more tips and who to call if you suspect abuse at DontHurtChildren.com.

– Erin Frazier, M.D.
Pediatrician, Norton Children’s Hospital
Medical Director, Children’s Hospital Foundation Office of Child Advocacy of Norton Children’s Hospital

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